MOC- “Lost Interest in My Baby”

“Lost Interest in My Baby”

29-year-old female who presents to the Emergency Department with complaint of headache. For the last week, she has been experiencing a gradually worsening headache. The patient is four weeks postpartum; since then has lost interest in her baby and has not been feeding her child. She dropped her baby three or four times.  Also reports memory problems.

•PE Vital Signs – BP 124/61, HR 71, RR 16

•Temp 98

•Normal exam – except for a flat affect

Post Partum Headache & Confusion

Differential Diagnosis ?????

What labs would you get?

–BMP

–CBC

–LFTs

–UA

–Utox

–CO

–Ammonia

–INR

ALL ABOVE LABS NORMAL

                        

Would you LP?

Prior to LP a Head CT was performed

Diagnosis???

Cryptococcal Meningoencephalitis

•Most common presentation of Cryptococcosis

•C. neoformans inhaled and spreads hematogenously to CNS

•Most commonly seen in immunocompromised patients

Clinical Manifestations

•Variable presentation some pts present with symptoms for several months-others present with acute illness only a few days

•Typical symptoms: Headache, lethargy, personality changes and memory loss often develop over 2-4 weeks

Diagnosis

•Lumbar puncture and CSF confirms diagnosis

•India Ink and/or cryptococcal antigen testing

Additional tests

•Cryptococcal antigen testing of CSF

•Spinal Fluid Cultures are positive in 90% of non – AIDS patients

Click "read more" for the questions/mini quiz.

QUESTIONS

1. Infection with the encapsulated yeast Cryptococcus neformans can result in harmless colonization of the _______, but it can also lead to the meningitis or disseminated disease, especially in persons with defective cell-mediated immunity.

a skin

b. prostate

c. lungs

d. bladder

2. Cryptococcus is the most common fungal infection of the central nervous system and may present as:

a. a space- occupying lesion

b. meningitis

c. meningoencephalitis

d. all of the above 

3. True or False: Cryptococcosis is the most common fungal disease in HIV-infected persons.

4. Historically the most common way to diagnose cryptococcus in the CNS was by: ______. Alternatives include cryptococcal antigen testing.

a. Canadian Pain Smear

b. German Clay Culture

c. Chinese Dy Droplet

d. India Ink Stain

5. Initial therapy in non-HIV infected patients should be:

a. Amphotericin B alone or in combination with flucytosine

b. Combination ginseng and saw palmetto

c. Medical marijuana

d. "double Z-pack"

Answers

1. c

2. d

3. True

4. d

5. a